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目的:对比分析新诊2型糖尿病(DM2)无遗传史者与有遗传史糖耐量正常一级亲属胰岛素第一时相分泌改变和胰岛素抵抗状态以及与DM2发病机制的关系。方法:选新诊DM2无遗传史者[TH(-)]25名及已确诊的DM2患者糖耐量正常的一级亲属[NH(+)]25名为研究组,无DM2遗传史糖耐量正常的健康人[NH(-)]25名为对照组。电化学发光免疫分析法测定各组空腹胰岛素(FIns)及静脉葡萄糖耐量试验(IGTT)后2min、4min、6min血清Ins含量。结果:①TH(-)组与NH(-)组比较,BMI、HOMA-IR升高有统计学差异(P<0.05),胰岛素各时段分泌水平无统计学意义(P>0.05),但空腹水平增高,IGTT负荷后,第一时相分泌达不到正常对照组水平;②NH(+)组与NH(-)比较,HOMA-IR无统计学差异(P>0.05),胰岛素空腹及第一时相各段分泌水平下降有统计学意义(P<0.01～0.05);③TH(-)与NH(+)组比较,TH(-)组HOMA-IR、FIns、6minIns水平高于NH(+)组有统计学差异(P<0.01～0.05)。结论:无遗传史新诊DM2患者存在明显的胰岛素抵抗,有遗传史正常糖耐量非肥胖一级亲属第一时相胰岛素分泌功能下降,不同人群2型糖尿病发病的始动因素可能不同,临床在预防、诊治时应区别对待给予不同的干预措施。
OBJECTIVE: To comparatively analyze the first phase insulin secretion and insulin resistance and the relationship with the pathogenesis of DM2 in new-diagnosed type 2 diabetes mellitus (DM2) without genetic history and first-degree relatives with normal history of glucose tolerance. Methods: Twenty - five newly diagnosed DM2 without genetic history [TH (-)] and 25 normal first - degree relatives [NH (+)] with confirmed DM2 were studied. There was no DM2 genetic history with normal glucose tolerance Of healthy people [NH (-)] 25 as control group. The contents of Ins in serum were detected by electrochemiluminescence immunoassay at 2min, 4min and 6min after fasting insulin (FIns) and intravenous glucose tolerance test (IGTT). Results: Compared with NH (-) group, the levels of BMI and HOMA-IR increased significantly (P <0.05), while there was no significant difference in insulin secretion at different time points (P> 0.05) (P> 0.05) .HOMA-IR had no significant difference between NH (+) group and NH (-) group, insulin fasting and the first time The level of HOMA-IR, FIns, 6minIns in TH (-) group was higher than that in NH (+) group in TH (-) and NH There was a statistically significant difference (P <0.01 ~ 0.05). CONCLUSIONS: There is a significant insulin resistance in newly diagnosed DM2 patients without genetic history, with impaired glucose tolerance in first birth relatives of first-degree relatives of first-degree relatives with impaired genetic history. The initiating factors of type 2 diabetes in different populations may be different. Prevention, treatment should be treated differently to give different interventions.